Medication nonadherence is a common challenge in hospital medicine, but understanding why a patient is not taking a medication as prescribed can be difficult.
In a recent Journal of Hospital Medicine perspective, Benjamin Hoemann, MD, proposes using the Capability, Opportunity, Motivation, Behavioral (COM-B) framework to help clinicians systematically identify the factors contributing to medication nonadherence.
Hoemann, a leader in addiction medicine within the Section of Hospital Medicine, describes how the COM-B model can serve as a diagnostic framework for clinicians caring for patients who have difficulty taking medications as prescribed.
The COM-B model is commonly used to understand the factors that drive behavior. The framework considers three elements: capability, opportunity and motivation. Together, these factors can help clinicians look beyond the simple question of whether a patient is taking a medication and consider what may be contributing to their behavior.
Hoemann argues that applying a systematic framework such as COM-B could help hospitalists identify the underlying contributors to medication nonadherence in clinical settings. Understanding those contributors may, in turn, help clinicians determine how best to address them.
The perspective builds on existing research showing that medication nonadherence is associated with health care use, including emergency department visits and hospitalizations. Rather than viewing nonadherence as a single, uniform problem, the COM-B approach offers a way to organize the different behavioral factors that may influence medication-taking.
“Medication nonadherence is rarely just a matter of not following instructions,” said Hoemann, who is also a T32 Postdoctoral Research Scholar in the Department of Psychiatry at WashU Medicine. “Using the COM-B framework as a bedside diagnostic schema can help hospitalists (and other clinicians) identify whether barriers are related to capability, opportunity, or motivation, and then tailor interventions accordingly.”
Read the full paper: The COM-B framework as a diagnostic schema for medication nonadherence